What is a Learning Collaborative? March 02, 2017

Definition of Collaborative Done with or working with others for a common purpose or benefit; "a cooperative effort“ (The Free Dictionary) Working together toward a common end (Answers.com)

Criteria for Topic Selection “Ripe for Improvement” Current prevailing practice deviates from the best scientific knowledge. Improvements would produce clearly positive results by reducing costs and improving quality. The possibility of breakthrough improvement had been demonstrated by at least some “sentinel” organizations. From The Institute for Healthcare Improvement White Paper: The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement © 2003 The Institute for Healthcare Improvement. Available at www.ihi.org

Key Elements of Design Combine subject matter experts in specific clinical areas with application experts who could help organizations select, test and implement changes. Organizations commit to working for 6‐15 months. Alternate: Learning Sessions: In person to learn about topic and to plan changes. Action Periods: Teams worked in their organizations and test changes in clinical settings. Structure Aim & Charter Define the problem and the goal: Close a gap. “50% reduction in adverse drug events.” 80% of teams to reach 4 on scale (improved outcomes). Time limited Change Package Known changes based on published evidence and successful work. Includes the “what” and the “how.” From The Institute for Healthcare Improvement White Paper: The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement © 2003 The Institute for Healthcare Improvement. Available at www.ihi.org

Structure Measurement Strategy Assessment Scale Standard measures that align with collaborative aim and goals. Combination of outcome, process & balancing. Assessment Scale Linear scale to assess implementation and improvement. Trajectory with goals based on timeline.

Activities to Support Learning & Sharing Learning Sessions – usually 3 Progress towards “all teach, all learn” Website for sharing information Monthly Reports Use of assessment scale for progress All‐team calls/webinars Workgroups on focused topics Listserve or discussion board

Breakthrough Series Model From The Institute for Healthcare Improvement White Paper: The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement © 2003 The Institute for Healthcare Improvement. Available at www.ihi.org

Key Aspects of Collaboratives Focus on closing gap of a known problem with known solutions. Standard model for the work IHI uses The Model for Improvement Fast paced with timeline for goals Standard measures Working participation required Sharing required “All teach, all learn”

Characteristics of Collaboratives Structured leadership roles Director, improvement advisor, project manager Clinical, subject matter experts Clear aim(s) or context for the collaborative One common aim or set of aims or individual aim(s) within a specific scope? Measurable, quantifiable, with dates Improvement Methodology Measurement Plan Learning System Design Reporting, activities, sharing, assessment Learning happens: At the place where individual sites are working on improvement – they learn what works and what does not to help them reach their objectives of better care and better outcomes for “those” they serve. When sites share and discuss with other sites. When the changes and results are consolidated, analyzed and synthesized across sites to determine what changes can be implemented effectively in a range of environments. When others not involved in the collaborative are exposed to this information. From: Learning System Standards for Health Care Improvement USAID Health Care Improvement Project 5 September 2010

Design of a Learning System for Improvement If we draw lessons from complexity science, we can see that the design of an effective learning system for improvement must be simple, adaptable in complex improvement environments and capable of being applied in different ways, according to local circumstances. From: Learning System Standards for Health Care Improvement USAID Health Care Improvement Project 5 September 2010

Key Activities CAPTURE SHARE PACKAGE DISSEMINATE Approaches, lessons, results SHARE with each other and Collaborative leaders PACKAGE Document and organize content DISSEMINATE multiple media & approaches

CAPTURE Participants Collaborative Leaders Document learning: What is tested What works and fails Lessons Learned Strategies (How) Results (data) Review and Assess: Access and Review learning and results from participating Identify opportunities for sharing

SHARE Participants Collaborative Leaders Share learning & results with Collaborative leaders and peers Actively participate in group activities Connect with peers for ideas, questions, feedback Promote and encourage sharing between ALL Schedule sharing activities (e.g. webinars, case studies, virtual and in-person events)

PACKAGE Participants Collaborative Leaders Document work, data, lessons and results Share tools and resources Harvest participant documentation Assess and organize for commonalities Develop and create packaged content (driver diagrams, change packages, guides, tools, resources, etc.)

DISSEMINATE Participants Collaborative Leaders Share learning & results broadly Participate in dissemination activities Identify best practices Organize multiple methods for dissemination (e.g. webinars, conferences, publications, etc…)

Questions to Answer By Participants By Collaborative Leaders How will we document data, results, etc.? How will we share tools, resources, materials, etc.? How will we access participants documentation? How will we review and assess? How will we promote and encourage sharing? How will we schedule sharing of activities? How will we harvest and package content? How will we plan for dissemination?

Participants Needs Team Roles Defined Requirements Defined Who is needed for the work What are the key roles for this work Requirements Defined Reporting What, how often, where/how Actvities Schedule and Timeline of Activities Estimates of time involved

Recommendations for SUCCESS Determine Aim(s) of the Collaborative Select and Improvement Methodology that will be used (This is the blueprint for the work) Form Team(s) With Key Roles defined Develop and Overall Plan Including all collaborative needs & Timeline Provide Materials for the participants and ALL involved Share Widely